Insurance Education and Advocacy

Individuals seeking insurance coverage for behavioral health and substance use disorder face low coverage, high costs, and denial after denial. Changes need to occur in order to allow insurance companies to provide necessary treatment to this population of patients.

We are unable to properly track and evaluate care access and delivery due to a lack of data. This is because many behavioral health and substance use providers do not participate in insurance plans, so consumers go out of network for care, limiting our ability to track the experience and challenges these consumers face.

Lastly, pooling together healthy, young individuals with the high cost individuals makes health insurance plans unaffordable for the healthy. Healthy individuals opt out of paying for expensive health insurance plans, thereby increasing the risk and cost of the insured, which only increases prices in subsequent years.

The Opioid Action Team envisions improvements in this domain through education and advocacy. Many consumers are not aware of their rights to appeal denials or the assistance available from the Office of the Healthcare Advocate. We need to increase awareness through social marketing and education. We also need to advocate for improvements in the appeals system. Of course, advocacy is needed regarding standards of care, data tracking, and affordability.

Helpful Resources

• The Office of the Healthcare Advocate is an independent agency that provides free help for people to understand what options you have, how to get and fight for your healthcare coverage, including coverage for mental health or substance use treatment, and to make sure you get covered for your healthcare needs. 1.866.466.4446